Ethical Conversation Research Articles

Conversations in Ethics

Conversations in Ethics

Nurses’ knowledge and skills in colonoscopy patients’ pain management

This study aimed to describe the knowledge and skills of nurses in managing pain during colonoscopy procedures. Colonoscopy is a procedure to diagnose diseases of the intestine, and patients consider it even painful. However, few studies have described patients' pain management during the colonoscopy procedure. A quantitative survey design was used. The data were collected from colonoscopy nurses with a self-completed semi-structured questionnaire developed for the study. The hospitals performing colonoscopies in Finland, with the exception of the ones where the questionnaire was pilot-tested, were included in the study (n = 12). The optional sample was drawn by mailing questionnaires (n = 147) to endoscopy units to be filled in by three colonoscopy nurses during 2002. The response rate was 79% (n = 116). The majority of nurses used versatile non-pharmacological methods of managing pain and had practice-based knowledge of pain management during the colonoscopy procedure, but pain education and the acquisition of new professional knowledge were rarely reported. Pain scales were not in use and ethical conversation was lacking among the endoscopy staff in most (95%) hospitals. The study showed that colonoscopy nurses used numerous non-pharmacological methods, but only rarely acquired professional knowledge. There was a lack of pain scales and ethical conversation in the participating endoscopy units. The results can be used to improve the treatment of pain during colonoscopy procedures and endoscopy nurses' education. Nurses should be motivated by education and ethical conversation. Future studies should aim to analyse patients' own evaluation of pain during the colonoscopy procedure. The applicability of the existing pain scales and non-pharmacological methods should be tested in practice.

Limits of Autonomy in Nursingʼs Moral Discourse

This article critiques the dominance of the discourse of autonomy in nursing ethical conversations, and the ways in which it is linked with nursing's commitment to patient advocacy. In its current discursive form, autonomy is too often used to reinforce the position of those already privileged and exacerbates the challenges faced by those with social vulnerabilities. Nursing's historical identity provides both challenges and resources for developing alternate ethical values. We have allowed narrow understandings of autonomy and advocacy to dominate our ethical discourse and have relied too exclusively on them to resolve conflicts and guide practice.

Containing Uncertainty

SUMMARY This essay reflects on one dimension of the challenge of being a queer ethicist. Can we have norms/values without liberal assumptions that might undo the important contributions of queer theory? The reemergence of appeals to “citizenship” in lbgt and queer debates serves as illustrations of this question. Reading Weeks's Invented Moralities: Sexual Values in an Age of Uncertainty (1995), while considering various scholars who have engaged the issue of sexual citizenship since, enables me to illustrate some of the issues that emerge around ethics and queerness at this particular moment. My argument is that attempts to offer constructive ethical engagement in the end often contain challenges rather than successfully address them. Critically examining Weeks's intervention into what he sees as our “loss” of moral authority and ethical concerns to the right wing is helpful for queer ethical conversations that consider available theoretical and philosophical models of claiming citizenship as a way of claiming values in uncertain times. Weeks (1995; 1998), Richardson (2000), Bell and Binnie (2000), and Phelan (2001) provides helpful guides to the struggle with tensions that faces us in lbgt/queer debates of citizenship.

Moral Deliberation in Psychiatric Nursing Practice

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings.

Geography and Ethics: Everyday Mediations Through Care and Consumption

Some months ago, in preparation for compil-ing the next three geography and ethicsreports, I registered with one of the commonelectronic database services to receive thetitles of journal articles focused on ethics.There are two things that I found noteworthyabout this exercise. The first is the sheer vol-ume of contemporary work on ethics – by myrather unscientific reckoning, something ofthe order of 1500 articles dealing with ethicsare published in academic journals each year.The second is the presumed audience formuch of this work. It seems that the vastmajority of recent ethical writings are aimednot at the readers of social science journalslike this one, but rather at the mundane worldof institutions, organizations and public policy.In recent months, articles have addressed theethical dimensions of a wide range of socialand organizational practices, from auditing tozoo keeping. Ethics are being discussed bybankruptcy lawyers, money managers, judgesand dentists, and applied to our sportingevents, our militaries, and even our spaceagencies. Ethical conversations, it seems, aretaking place at a multitude of sites across thesocial domain.This state of affairs should probably beapplauded. But it does not necessarily ensurethat our social institutions function ethicallyor responsibly, or even that we can easilydetermine what that might mean. At issuehere is a common challenge of ethical think-ing: how do we bring normative demands tobear upon the social world of order, rules, andpublic policy? One well-known theorist whograppled with this challenge is EmmanuelLevinas, who often admitted that his concep-tion of ethics, based as it was on a one-to-onerelation with the singular Other, was ratherdifficult to translate into a social world ofcitizen-subjects:

Shakespeare's Noise (review)

Reviews479 Kenneth Gross. Shakespeare's Noise. Chicago: University of Chicago Press, 2001. Pp. xi + 282. $42.00 casebound; $16.00 paperbound. The subject of Kenneth Gross's new book, Shakespeare's "noise," is "disorderly forms of speaking: slander, defamation, insult, vituperation, malediction, and curse"; "the violence that the human tongue does to human ears" (1). The eloquence of these introductory phrases is sustained throughout the book, as we see when Gross calls the plays' interplays ofnoise and silence an "ethical conversation " (2), describes how Measurefor Measure's duke "moves through the play as an isolated, occulted ear," and says Coriolanus's "true and ancient enemies are not Volsces but voices" (139). The near-poetry of Gross's own voice makes Shakespeare's Noise a pleasure to read. No less commendable is the way the author's close, careful readings of Shakespeare remain anchored in the plays' fundamentally performative context. To Gross Shakespearean noise is not just a thematic phenomenon but an auditory circumstance, a mode bywhich spoken words, voice tones, other sounds, and even silences contribute to the audience's sense ofthe plays' meanings. While the discussion in this book ranges widely over Shakespearean and even modern plays, it focuses chiefly on Hamlet, Measurefor Measure, Othello, Coriolanus, and King Lear. Strongest are Gross's first, third, and fifth chapters , wherein he examines Hamlet's concern with "[w]ounded names" (14), Duke Vincentio's "prophylactic" hearing in Measure (79), and Coriolanus's preference of "War Noise" to "public language" (139). In his first chapter, anatomizing mostly Hamlet's speech, Gross points to the prince's guardedness of inner self against wild, name-wounding rumor, a damaging wind that transforms truth to unmerited "censure" (to use Hamlet's word). Gross illuminates Hamlet's anger at Guildenstern's attempt to "sound [him]," or play him like a pipe, by comparing Hamlet's lines to those spoken by "[r]umour, painful full oftongues," in 2 Henry TV: "Rumour is a pipe / Blown by surmises, jealousies , conjectures" (24). (Later, Gross ingeniously uses Rumour's costume to cast light on a famously awkward line in Coriolanus, wherein Roman citizens vow to "put [their] tongues in Coriolanus' wounds and speak" for the wounds; here Gross shows that Coriolanus fears his battle scars will somehow be replaced by public praise, a process he views as the exchange of fact for rumor [138].) Gross adeptly shows that Hamlet's early claim to have "that within which passes show" is borne out byhis play-long refusal to reveal the truths he knows about others. Attackingas slanderers those who, like Guildenstern, would claim to "pluck out the heart of [his own] mystery," Hamlet yet uses slanderous hints to force self-knowledge in others. "Hamlet does not work by directly pointing out some hidden truth," Grosswrites:"Rather, he says things that make 480Comparative Drama others think, or suspect, he has knowledge ofthem... . This means that Hamlet's knowledge is in part something others project onto him (by which they betray themselves, in both senses of the word)" (21). Thus Hamlet's slanderous accusations lead to other characters' (Claudius's and Gertrude's) legitimate selfaccusations , a process that bears out an ancient association between slander and accusations. The oblique slander Hamlet utters is, paradoxically, an agent ofjustice. Building on this association between slander and justice, Gross focuses his second and third chapters on slander and law. His second chapter examines Renaissance accounts of slander in texts as dissimilar as the Psalms and the imprisoned Essex's letter to Elizabeth I, in which Essex expressed fear of being played "in what forme [his detractors] listfed] upon the stage" (43). These examinations culminate in Gross's fascinating argument that slander mimics the operations oflegal censure: the "voices ofillicit accusation . . . show motives that echo the aspirations ofjustice itself" (56). The reader might wish Gross had made a more explicit connection between this insight and the action of MeasureforMeasurewhen he turns, in this third chapter, to that play (and also—for I must say this somewhere—that he had curtailed his enthusiasm for explanatory notes. Fifteen pages ofnotes expand the second chapter's arguments; sometimes the reader must flip back and forth between text and notes every...

Recovering ethics after 'technics': developing critical text on technology.

Much modern science and ethics debate is on high-profile problems such as animal organ transplantation, genetic engineering and fetal tissue research, in discourse that assumes technical tones. Other work, such as narrative ethics, expresses the failed promise of technology in the vivid detail of human experience. However, the essential nature of contemporary technology remains largely opaque to our present ethical lens on health care and on society. The limited controversies of modern science and ethics perpetuate 'technics', a technical, problem-solving mindset that fails to grapple successfully with the complexity of technology. A critical dialectic between practice and scholarship widens the ethical conversation in nursing to consider technology as an ongoing set of daily and fundamental moral choices on how we live. Critical text on technology recovers ethics from the limits of technics, and assists nurses to develop an inherent knowledge of technology that is needed to provide ethical care in a technological world. There are overlooked ethical challenges in the mundane, everyday routine activities of professional practice, and these have gone largely unexamined. Ethical behavior is not the display of one's moral rectitude in times of crisis. It is the day-to-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions.

The ethics and economics of patenting the human genome.

This paper attempts to better define the areas of conflict and agreement between value ethics and the theoretical ethics of the market processes at work in the biotechnology industry. Despite the apparent lack of ethics in an oligopolistically competitive pharmaceuticals industry, the paper concludes that the current stage of development of the medical biotechnology subindustry offers unparalleled opportunities for ethical systems to influence the market-based development of biotechnology. Ethical conversations between doctors and biologists with ethicists can help the market absorb more of the reflective wisdom that ethics brings when discussing such issue areas as justice, patents of the human genome, and modifications of the human genome. If conversations between ethicists and biotechnological managers and doctors are successful the metaphors of market-based financing may be refined and the knowledge base of the good increased.

Ordinary Language Criticism: A Manifesto

KENNETH DAUBER Ordinary Language Criticism: A Manifesto I love theory, but I love practice more. John Neal, Rachel Dyer 'hen convictions are hard to come by, skepticism must serve instead. But we need, all the more, the courage of our skepticism, lacking which even faith may be a preferable attitude for criticism to assume. I wish to propose such a critical faith—a faith which skepticism, conceived generously enough, in fact elicits. For the moment, however, to elaborate the context in which such a project finds its urgency, what needs attention is the peculiar weakness with which much of current American criticism entertains both the one and the other. It is a weakness, especially, in current criticism of American letters, where the result has been an impasse that threatens even the considerable achievements of such criticism in opening the American literary landscape. Thus despite its recent successes in undermining long-established traditions of language and literature, criticism in the skeptical vein has not quite come to terms with its need for the very idea of tradition, which seems indispensable for establishing alternative literatures. Its revolutionary aims of unsettling canons and histories come into conflict with its simultaneous goal of settling new histories and new canons. Its skepticism and its faith work at cross-purposes. And, indeed, they must. For they will not really work at all until they work together. Ungrounding canonical America must appear a pecuArizona Quarterly Volume 53, Number 1, Spring 1997 Copyright © 1997 by Arizona Board of Regents ISSN 0004-1610 124Kenneth Dauber liarly incomplete enterprise so long as a canon without grounds has not been fully attempted. Establishing new voices and new literatures must remain a dream so long as doubts about voice and literature are not themselves what establish them. And perhaps, it should be admitted, it is easier to dream than to come to terms with the consequences of revolution , with the responsibility that a skepticism or a faith large enough to embrace requires. Perhaps it is easier to temporize than to confront what might really be doubted and believed, what grounds criticism might in fact choose to stand on, after all. The situation is not unfamiliar in literary studies. This is not the first generation to become disaffected with what seems a previous generation 's limitations, only to find itself caught in limitations of its own. Still, this generation's formulation of its disaffection in the global terms of post-modernism has created something of a crisis. Revisionism cannibalizes itself, as the post-modern de-privileging of any current moment as a point, for better or worse, of larger enlightenment than what has come before turns the mere partiality of this time and that place from a provocation to further work into a kind ofgeneral philosophical debility. Not only previous authority, but all authority is discredited. The idea of literary history as a conversation among ethical subjects is now almost universally read as serving particular political interests. Yet, seeking a more ethical history, or at least a more ethical conversation, has, accordingly, seemed to mean invoking other interests—no less political—and thus generating a double-bind of politics from which it would appear impossible to escape. Clearly, European formalism and a native reformism have not blended well. Eschewing, as insufficiently radical, the more pragmatic skepticism that runs in an American line from Franklin through Emerson to William James for the transcendental analytics of deconstruction, American critics have still, almost from the first, wrestled with deconstruction's radical destabilization of the authority of society as such. De Man's stoicism—the power of unsaying Derridean aesthetictsm—unsaying stylized as you want it—have never seemed to them an adequate compensation for the inability to say, any longer, what is wanted. And so, saying what is wanted has remained to trouble their discourse, however post-structural it may seek to be.1 For a forceful example ofthe difficulty, we need look no further than de Man and Derrida themselves. In their American phases, they too exhibit a kind of bad reformist conscience about their formalism, and so Ordinary Language Criticism125 the history of their careers reads as a painful new history of wrestling with...

The Editorial Board of "The Journal of Law and Religion" Presents This Award to Thomas L. Shaffer for a Lifetime of Important Contributions to the Discipline of Law and Religion

As a lawyer, law teacher, dean, scholar, colleague and friend, you have lived what you have taught, that lawyering is a vocation most faithfully lived in friendship. A prodigious scholar, you have led us as a brilliant pioneer into our past, turning us again toward ethics as a way of life lived in reflection and discomfort, not a decision of the moment, and situating the good lawyer within her community of memory. You have told many of the old tales, making way for a return to story-telling as ethical conversation for law scholars. In your deceptively accessible writings, the daily tasks of the lawyer are honored and challenged within a rich texture of literature, religion and law. Your life of professional service, proceeding from a major law firm to Dean of Notre Dame Law School to clinical teacher, bespeaks the courage and humility with which you explore the religiously committed lawyer's vocation. Your affirming presence as a listening, generous, humorous and insightful friend to those whom you love and those whom you hardly know, has brought strength to the lives of many others. We honor your willingness to speak of God in public places, to help us meditate on the work of the lawyer, and to affirm our halting efforts to live whole lives as faithfully religious and faithfully professional men and women.